title: Endovascular treatment of delayed rupture following prior abdominal aortic aneurysm repair achieves better survival rates.
abstract: OBJECTIVE
  To test the hypothesis that endovascular treatment of delayed aneurysm rupture achieves significantly better survival rates compared to surgical conversion.
  
  
  METHODS
  All patients sustaining delayed rupture following prior exclusion of an abdominal aortic aneurysm (AAA) either by endovascular aneurysm repair (EVAR) or open graft replacement from March 1995 through December 2011 were retrieved from a prospectively maintained database at a tertiary care university hospital. During the study period, 35 patients (32 men; mean age 72.9 years) presented with delayed rupture at a median 2.4 years (interquartile range 1.3-4.3) after initial AAA repair by EVAR (n=22) or open surgery (n=13). Causes of post-EVAR rupture were graft-related endoleaks, while ruptures after open repair occurred at anastomotic suture sites. Patients were divided into groups regarding type of treatment for delayed rupture: 20/35 (57%) underwent successful EVAR (10 redo procedures), 13/35 (37%) had surgery (3 redo procedures), and 2/35 (6%) patients received comfort care only. The primary endpoint was 30-day mortality.
  
  
  RESULTS
  The 30-day mortality after curative treatment was 25% (5/20) for endovascular treatment compared to 54% (7/13) for surgery (p=0.14). Including additional deaths beyond 30 days, the overall in-hospital mortality was 52% (17/33). The Kaplan-Meier survival estimate for patients undergoing endovascular treatment was significantly higher (p=0.011).
  
  
  CONCLUSIONS
  Endovascular treatment of delayed rupture is feasible and helps to reduce mortality. Our data suggest that endovascular procedures are a superior treatment option for EVAR-suitable patients with delayed rupture compared with surgical conversion.
authors.affiliation: 1 Departments of Vascular Surgery, Medical University of Vienna, Austria.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Prusa
authors.forename: Richard
authors.initials: R
authors.lastname: Nolz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Wibmer
authors.forename: Maria
authors.initials: M
authors.lastname: Schoder
authors.forename: Johannes
authors.initials: J
authors.lastname: Lammer
authors.forename: Peter
authors.initials: P
authors.lastname: Polterauer
authors.forename: Georg
authors.initials: G
authors.lastname: Kretschmer
authors.forename: Harald
authors.initials: H
authors.lastname: Teufelsbauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D057867:Endoleak / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome